Impact of Psychiatric Illness on Clinical Outcomes of Patients With Multiple Rib Fractures: Insights From a National Trauma Database

ObjectiveThe objective of this study was to compare in-hospital outcomes and mortality in patients with and without a psychiatric comorbidity that presented to a trauma center with isolated blunt chest trauma and multiple traumatic rib fractures.Materials and MethodsThis is retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program database (2014-2016). Patients ≥18 years with ≥3 traumatic rib fractures were stratified based on the presence or absence of a psychiatric comorbidity. In-hospital complications, length of stay, intensive care unit (ICU) admission, and mortality were assessed. Variables significant (<i>P</i> < 0.05) on univariate analysis were entered into logistic regression models to determine the independent effect of a psychiatric comorbidity on outcomes.ResultsAmong the 56,558 patients meeting inclusion criteria, 10.6% (n = 6022) had a psychiatric comorbidity. On univariate analysis, patients with a psychiatric comorbidity demonstrated significantly worse in-hospital outcomes, including higher rates of acute respiratory distress syndrome (ARDS) (1.0% vs 0.7%), deep vein thrombosis (DVT) (1.5% vs 1.2%), pulmonary embolism (PE) (0.8% vs 0.5%), pneumonia (4.2% vs 3.1%), urinary tract infection (2.4% vs 1.7%), and decreased mortality (2.2% vs 3.5%). After controlling for comorbidities, substance use, and demographic factors, psychiatric comorbidity was an independent predictor of ARDS (aOR 1.15, <i>P</i> < 0.01), DVT (OR 1.32, <i>P</i> = 0.017), PE (aOR 1.40, <i>P</i> = 0.004), pneumonia (aOR 1.36, <i>P</i> < 0.001), and decreased mortality (aOR 0.71, <i>P</i> < 0.001).ConclusionsThe presence of a psychiatric comorbidity increases in-hospital complications independent of patient characteristics, comorbidities, and trauma burden in patients presenting with multiple traumatic rib fractures.